Elizabeth Edwards Taught Lesson About Decisions to End Treatment

Just a day after announcing she stopped all cancer treatment, Elizabeth Edwards has died, ABC News has confirmed.

Between September and late November, Edwards' health went into decline. Her breast cancer spread to her liver, and eventually reached the point where medical treatment was ineffective.

Although she was well enough to make public appearances just a few months ago, medical experts who are not involved with Edwards' treatment say it's not unusual for metastatic breast cancer to progress quickly into its final stages.

"Once the last of all of the likely therapies stops working, it is typical for deterioration to be quite rapid," said Dr. Harry D. Bear, professor of oncology at Virginia Commonwealth University in Richmond, Va.

Edwards' cancer was reportedly the estrogen receptor-positive (ER-positive) type, meaning the cancer grows in high-estrogen environments. Doctors say it's the most common form of breast cancer, and is also the type that leads to the most deaths.

"More breast cancer patients die from ER-positive cancer that's become resistant to anti- hormone drugs than any other type of cancer," said Dr. Matthew Ellis, professor of medicine at Washington University School of Medicine in St. Louis, Mo. "The cancer relapses despite the use of these drugs."

Decision to End Treatment "Gut-Wrenching"

Medical experts say how long to continue therapy for metastatic breast cancer, which will eventually become resistant to therapy, is a difficult decision. It requires balancing the effectiveness of treatment and a patient's quality of life.

"The decision when to stop chemotherapy and focus on symptom management is one of the most
gut-wrenching we face, especially in breast cancer, because there are so many therapies with some chance of working, but that chance decreases with each successive regimen, while [treatment] toxicity remains the same or increases," said Dr. Daniel Hayes, clinical director of the Breast Oncology Program at the University of Michigan Comprehensive Cancer Center in Ann Arbor.

Experts also say the decision must involve regular communication between doctor and patient through the course of the disease.

"It begins at the time of diagnosis and is very patient-specific," said Dr. R. Sean Morrison, professor of palliative medicine at the Mount Sinai School of Medicine in New York. "We want to understand what are their values and goals and what are values of treatment."

He also said that doctors need to find out whether it's a patient's wish to live as long as possible no matter what, or to live a better quality of life without the side effects of chemotherapy.

"If somebody wants to live as long as possible, I am going to continue to recommend treatment until there's absolutely no benefit for them," said Morrison. "If it's important to not spend time in hospitals, I may make entirely different treatment decisions."

Cancer specialists say it's a discussion that many doctors unfortunately don't have with their patients.

"The patient will continue getting treatment despite potentially horrific side effects that interfere with her quality of life, and the oncologist continues to administer the chemotherapy, not wanting the patient to feel that he/she is giving up on her," said Lillie Shockney, an associate professor at the Johns Hopkins University School of Nursing in Baltimore.

"Doctors need to be educated that we have many other treatments besides chemotherapy," said Morrison. "Accompanying patients through a difficult illness, not abandoning them, and being there to listen to them is as important, if not more so, than prescribing one particular medication."

Research has shown that end-of-life care can actually help prolong life.

"It is an unfortunate myth that keeps being perpetuated that opting for palliative care shortens life," said Morrison. "When patients are comfortable, when the stress of pain is relieved, when their depression is treated, and their loved ones are supported, they actually live longer."

Final Days Full of Comfort and Love

In her remaining days, Edwards likely benefitted from the outpouring of support from the public as well as from having her loved ones around her.

"The dying process is different for every patient, but no one should have to die alone," said Ellis.

Ellis also said Edwards' family and friends probably took tremendous comfort in being with her at the end of her life.

"There is such a thing as a peaceful death, and the patient can reach closure with her loved ones."